11%, and hand writing it may even be much smaller, 2%-3% when you are not trying to fake their writing. fingerprinting it may be even higher. it is a rare example. before dna, it was the gold standard. they call dna genetic fingerprinting. the fbi has long testified they have a 0% error. in 2004, it was the first time someone convicted with fingerprint evidence was exonerate it. the fbi first publically --

publicly apologized for the train bombing in madrid. they thought they found his fingerprint on a bag of detonators in madrid, but they were completely wrong and had to apologize. this shows the fingerprint identification process is highly subjective. three drug reviewers reached the conclusion that his fingerprint was on the bad. even if it fingerprint turns out to be correct 90% of the time, it has never been steady. both sides are saying we should start with the fingerprinting. there's nothing to worry about, but because this is the best known discipline, other disciplines are likely to be weaker. let's move on from that to the others. host: last call, charlotte on the republican line from pennsylvania.

caller: i was wondering if he did speak to was a little bit about the current status of the federal judge's serving under maritime law and how they are not down to uphold their constitutional rights. how can the citizens protect our constitutional rights and be heard by constitutional lawyers as opposed to maritime judges? host: you can try to tackle that one or wrap up the reporting on forensic errors. guest: i'm not familiar with that issue. i would say the conclusion with the forensic errors is not to challenge it the hard working scientists that have been working on this for a long time nor the men and women who have been using these tools to keep the public's faith and the prosecutor criminals. -- keep the public safe and

prosecute criminals. what is the best way to incorporate it advancing science in the legal system? can it be used to improve? host: you can read more on washingtonpost.com and reported

my office overlooked the plaza and there was a day care center and of course some of the children were killed and others were injured but during the recess period they would always play in the plaza and to procure their voices so that last electing oppression when there was silence. a dear friend of mine just graduated working in the social security office and her father

was a good friend of mine and when i got home i had three different messages first of all of what could to find out what he could find out and secondly third message. this week in the senate members are taking a measure to overhaul the u.s. postal service. some legislation will limit executive compensation and prohibit the closing of post offices for two years. next, we hear from centers to the two senators jeff sessions

service act. i regret to say there is a fundamental problem with this bill that we have to address, and i wish it weren't so but i'm afraid it is. the bill would increase federal deficit by $34 billion. this violates the deficit neutrality provisions for spending that we adopted as part of the budget control act of last summer, just last summer. as a result, there are at least five budget points of order that lie against the bill, and i, ranking republican on the budget committee, will be raising points of order at the appropriate time. this means it would take 60 votes in the united states senate, 60. our hundred members to say we don't want to agree and follow the law we passed last summer, that we promised the american people would make a difference

and we'll just spend this money anyway because we think it has an important need. under the senate rules, no committee can bring a bill to the floor that spends even one penny more than already is going to be spent under the current law, or increase the deficit more than it would increase under current law. current law is the budget control act of last summer, and it was passed, as we all recall, as part of a major debate over the debt ceiling, the raising of the debt ceiling so we continue to borrow money, borrowing at the rate of about 40 cents of every dollar we spend is borrowed. we knew that had to end, so some decisions were made and spending was constrained although i would contend not nearly enough. in other words, the spending and debt under the postal bill violates the debt limit

agreement reached just last summer. in august we agreed to modest so insufficient savings. in fact, the discretionary spending under that bill is not even cut. last august we talked about big cuts, but the reduction in growth is what occurred, and spending this year would increase $7 billion over the spending of last year. and now the senate has already -- is already spending more than we agreed to at that time. this is particularly odd since the president and the senate majority leader have accused the house members, the republican house, of breaking the budget agreement by trying to save a little more money than the budget control act said that they should save. and this argument is not sound, of course. the debt deal established basic spending caps, basic limits,

the amount, maximumth amount that could be spent on discretionary accounts and not one word in that law prevents us or any member of congress from doing the duty to try to save more money. not one word in that law requires the congress to max out and spend up to that cap, to that limit. so this is not a matter of interpretation. caps are the maximum, not the minimum that we can spend. but this bill does violate that legislation. it spends above the agreed upon limits. so only in washington does spending below a cap get you accused of breaking a deal while spending more than the agreement explicitly states means people just look the other way.

the majority leader and the chairman of the budget committee are proud of the budget control act. they say it has ironclad restraints on spending. they say we don't even need a budget, which is clearly not accurate. but the budget control act did have certain spending limitations on us and they've been proud of those and they said those are sufficient to put us on a sound course, and we're going to follow those, they've implicitly said, i suppose. but where are they when it comes to making sure that this agreement they so proudly talked about is actually followed? it's curious that we don't have leadership from the majority leader, the budget committee chairman, to tell the committee look, we understand the postal

service has serious problems. we understand that. something probably needs to be done to fix that and improve that situation. it may even cost some money and we may need to come up with some money. but due -- to do so shouldn't we comply with the law of the united states in what we agreed to just last summer? so as this unfolds you'll hear some say that part of the reason that the spending increases are in the bill is because the bill requires the treasury to repay the postal service $11 billion that the postal service has in the past overpaid to the u.s. treasury, in effect, for retirement contributions of current employees. so i'm not debating that argument.

and whether or not it's an overpayment. i'm not debating that. we've got experts that have looked at and said it basically is accurate that the united states treasury does owe the postal service $11 billion. and under some circumstances maybe we are required to pay that back. i don't argue that at this point. what i would say is if we pay it back, is it not an expenditure of the united states? if you're behind on your car payment, and you have to make that payment, well, you have to make the payment. but don't you have to get the money from somewhere? and if you and your family have agreed to you're not -- agreed you're not going to borrow not so much but so much new money and shouldn't you look to see where you can cut spending to pay for that? that's all we're talking about here. certainly owing a debt doesn't mean you don't have to pay the

debt. but as a matter of coring scoring, a matter of integrity and accounting you have to understand that it costs money. the money comes from somewhere. most people understand, i think, that the united states government borrows money through t-bill sales and we pay inta on the money -- interest on the money we are borrowing and the fastest growing item in our budget is interest on our debt. so we ought to be cutting spending to pay for this if we need to pay for it. over ten years, that's $11 billion, well, that's a lot, but $11 billion is a little over a billion dollars a year, and this year alone we'll spend, as i recall, approximately 3,700

billion dollars. we couldn't find $1 billion a year to pay the money back? we have to borrow it in addition to the money we agreed to borrow, the debt limit we agreed on to breach? the $11 billion is only one third of the debt impact of the legislation. it is only one-third of the amount by which the bill breaks the agreement of last summer. so what else accounts for the total of $34 billion? most of the deficit increase from the bill, about two-thirds, would occur because the bill would reduce the amount that the postal service is supposed to pay to the office of personnel management to fund the future retiree health benefits under the current postal service employees -- or for them. coverage for when they retire.

and the postal service is famous for having good health care and good retirement programs, and what they're legally entitled to, somehow should be funded if at all possible. if there's money to fund it. in 2006, congress enacted the postal accountability act to set the postal service on a self-sustaining course. according to one of the managers of the bill, that law included -- quote -- "a requirement that the postal service endorsed at the time" -- close quote, a requirement that the postal service agreed to, that they would prefund the future retiree health benefits of the current postal employees on an accrual basis. and that 2006 law set out a schedule of those required payments to the government. now six years later, the postal

service does not want to make those required payments, or says they are unable to. we already enacted a bill last year partially relieving the postal service of some of their required 2011 payment, so this bill would defer those payments and stretch out the amount of time to pay them. how much is the postal service allowed to defer? $23 billion, almost, almost 23 more billion dollars. the legislation allows the postal service to defer $23 billion in payments for retiree health benefits. since the decision apparently that's been made and included in this legislation is that the users of the postal service, the stamp buyers, aren't --

shouldn't be required to pay this money. the idea is the taxpayers will pay the money. so the taxpayers will pay it. just pick it up. you know,ates tough thing, not enough money going into the health care fund. yeah, we promised that postal would stand on its own but don't want have enough money, so we're not so serious about paying this $34 billion total that we would actually find the money to pay for it. we're just going to add it to the amount that we're borrowing each year. and this year for the fourth consecutive year we will borrow about 1,300 billion dollars. it's an unsustainable path. so this means that the treasury has to go out and borrow the money over the next ten years because the postal service is relieved from making the health care payments.

again, a budget produced under regular order that i have truly felt we should have done and remain disappointed deeply that has not occurred, should have planned for this and would have planned for this, hopefully, by including policy changes somewhere else in the government that would have offset the deficit and the debt increase caused by this bill. and because the bill doesn't do that, because it adds to the debt of the united states, violates the pay-go requirements and the budget control act, i will raise a point of order and it will require the vote of 60 senators to waive it. if this new spending is necessary -- and i suspect some

of it may be -- then isn't it worth cutting spending somewhere else in this massive government to pay for it? do we really have to break our spending agreement before the ink is dry on it, the first real bill on the floor of the senate after the budget control act agreement of last summer violates substantially the spending limitations of that act. so this is at a time when we're facing the fourth straight deficit in excess of $1 trillion, the four largest deficits in had the history of the american republic. washington is in a state of financial chaos. we are in denial. we are not recognizing, owning up to the fact that we do -- there are limits on what we can do. you tell me how long we can

borrow a trillion dollars a year. how long we can spends substantially more than we take in and add the difference to the interest payment of the government every year. the government services administration is throwing lavish parties in las vegas, the government accountability office has identified $400 billion -- $400 billion -- maybe we could pay the $34 billion out of this $400 billion -- being spent every year, each year on waste. inefficiency and duplication. that's the official government accountability office. far worse, the senate's democratic majority has failed to produce a budget plan in calendar years between, 2011 and now 2012, in fact this sunday in fact marks exactly three years since the last time the senate has passed a budget. a budget means responsible behavior, it means that we know

there are many places we'd like to spend money. there are a lot of places we'd like to spend money. but since we know our money is limited, we adopt budgets, or we're supposed to doop a budget, there's an absolute legal requirement we do, it just doesn't require congress to go to jail if they violate it. so it requires, and forces congress to make tough choices. now we say the postal service needs more money, and we won't stay within our budget limits, we'll just borrow it and give it to them, knowing that this is not a responsible behavior but hey, we don't need to make tough choices, do we? because te senate can't say no and because the president refuses to exercise managerial discipline, we are set to spend another $34

billion in borrowed money. so the white house warns that republicans want to cut too much spending, but the american people know the truth, and the truth is that we have never spent more money than we are spending today, and spend it more recklessly and with less accountability than we have been spending the taxpayers' money. so this is in many ways a decisive moment. this is not a mere formality, phoeu budget point of order. -- my budget point of order. it is not just something i'm going through the motions of. i believe it's a crucial vote. now i respect so deeply my colleagues who have worked on this legislation. it is very complex. it is very important. it is a very difficult issue. this country has got to confront

rationally the difficulties in the postal service. the world is changing. e-mails and other things are occurring. i won't say this is a horse and buggy whip manufacturing system, but it has to alter to keep up with the times, and we can't just throw money at it. by throwing money at it often, you keep it from reacting to the realities of the situations they're in. so i respect deeply the people who worked on this, but i do believe it's a crucial vote. even if one supports every dollar of spending in the bill, colleagues do you support a violation of the budget control act in such a dramatic fashion so soon after it was adopted? vote to sustain the budget point of order. that's what i ask my colleagues to do. let's stand up for fiscal responsibility. in effect, it would send the bill back to our good committee

and it would say to them look at it. if you can spend less, please do so. but if you feel you have to spend money on this postal fix, find out where it should be paid for. propose how it should be paid for. and that would meet the requirements we made through each other just last summer. it would meet the requirements that we and the promises we made to the american people. we said, okay, we're not raising the debt limit until you agree to spending cuts. and that was a total of $2.1 trillion in spending cuts. and we agreed that we wouldn't increase the debt limit more than the amount approved in that legislation. we wouldn't increase the debt over that amount. we would honor the paygo rule. that was part of that legislation. that's what we promised each

other, and the american people. we don't need to violate that now. and remember, a vote to sustain the point of order would not kill the postal reform bill. but a vote to waive the point of order and just spend the money would be a vote to ignore spending requirements and would, i believe, kill our professed commitment to fiscal responsibility. so, mr. president, i thank the chair for the opportunity to share these remarks. i see we have as much of a, is as much of a $34 billion problem here. it's going to be difficult to fix it but certainly not impossible. i would hope if this bill with. the presiding officer: without objection, so ordered. ms. collins: thank you, mr. president. mr. president, let me start by

responding to the ranking member of the budget committee by saying that i could not agree with him more that it is absolutely unacceptable that we have not had a budget pass in the senate for more than 1,000 days. that is totally unacceptable. it's one of the reasons that we are in such a financial crisis in this country. so, i completely agree with senator sessions that we should be doing a budget resolution on the senate floor. and i wholeheartedly agree with his comments that it is absolutely irresponsible for us to be proceeding without a budget resolution. and as a member of the appropriations committee, i would say to my colleagues that

it makes it very difficult for us to carry out our work due to the cooperation of the chairman and ranking member of that committee. we are operating under allocations for each subcommittee. but it would be far, far preferable if there were a budget resolution that passed, and it should have passed last year, the year before. and it should be passing this year. so we're in complete agreement on that point. and i know that's been a great source of frustration for the senator from alabama, as the ranking member of the budget committee. having said that, mr. president, let me explain a few facts. first of all, there are no tax dollars being authorized by this reform bill. there is no transfer of taxpayer money to the postal service.

what we have here is a very strange and unusual budget situation, and the score that c.b.o. has is incredibly misleading because the postal service, oddly enough, is part of the unified budget of the united states, even though most of its accounts are off-budget. but it participates in federal employee retirement systems and the health benefits systems and the workers' compensation systems, where postal dollars that come from postal employees and from ratepayers, postal ratepayers, are commingled, if you will, with tax dollars that

come from other federal agencies into the retirement system, the workers comp system and the health benefits system. and that creates this odd situation which makes it very difficult for c.b.o. to score this bill correctly. now, the inspector general of the postal service puts a -- it far more bluntly. the inspector general says in a february 22 report from this year called "budget enforcement procedures and the postal service" -- and let me quote. the i.g. says, "the postal service's off-budget status exposes the postal service to,

quote, an inappropriate and illogical application of the scoring process that threatens its ability to reform and heal its financial condition. scoring and budget enforcement were created for a good purpose, but they are undermined when the scoring process assumes that unlikely or inappropriate inflows to the treasury must occur." end quote. let me give you a couple of examples because it's incredibly important that we walk through the score so that our colleagues can understand the unique on-budget, off-budget status of the postal service. particularly in the area of reducing payments to retiree health benefits or recovering overpayments to the fers system and how the c.b.o. scoring

method obscures the true savings achieved by refunding the fers payments. now, again, let me repeat. since 1971, the postal service has received no federal subsidy to operate other than some very minor appropriated dollars for functions that the postal service is legislatively mandated to do, such as mail for the blind and overseas ballots for our troops. that's it. prior to 1971, there was a taxpayer subsidy year after year to the postal service. that ended with the postal reform act in that year. so from the sale of stamps, the

cost of shipping packages, the rates that mailers and magazine publishers, newspaper publishers pay to get the print versions delivered comes the revenue for the postal service. and even the money that the postal service uses for retiree benefits comes from the combination of the contributions the postal workers make and the money that the postal service invests. so there is, as i mentioned earlier, a significant overpayment into the federal employees retirement system, and we, along with the administration, the g.a.o., the independent actuaries, the postal service inspector general all have proposed that that overpayment be returned to the

postal service. and it would be used in part to finance these buyouts and retirement incentives to reduce the size of the postal workforce. now, let's look at how c.b.o. scores this particular part of the bill. first of all, c.b.o. gives this bill no credit whatsoever for the buyouts, and here's why: c.b.o. argues that the postal service already has buyout authority. but, mr. president, as you know better than anybody in this chamber, our bill changes the status quo in two critical ways. first of all, the postal service

has no cash right now to do these buyouts. that is one of the reasons that we're so eager to get the money from the overpayment to fers refunded to the postal service. second, in our bill, in our substitute bill, we specifically direct the postmaster general to use a portion of this money to entice 18% of the current postal workers to accept this offer. that is a big difns. so there is -- that is a big big difference. so there is a mandatory move to reduce the workforce by 18% and there's the cash to allow tom offer buy -- to allow him to

offer buyouts to do that. now, why c.b.o. doesn't do that as a savings to the postal service is beyond me. now, there's another way to reduce the workforce, and again the funds for this would come from the fers refund. and that is, our bill provides new authority to the postal service to offer one or two years of credited service toward a pension annuity so that some worker who's just lacking a year or two in -- to reach the number of years necessary for retirement could be credited with that extra year or two of service, depending which retirement system the worker is in. unfortunately, the c.b.o. gives -- makes an assumption that only

several thousand employees would take advantage of that offer and credits the bill with savings of only $643 billion over ten years. since these kinds of service credits have never been offered before, it's not clear how the c.b.o. came up with this assumption. this is a know precedent for it. there are no data for the c.b.o. to use. and, again, our original bill did not include the hard requirement for the 18% reduction. but our substitute does. and yet c.b.o. does not recognize that change. now, the postal service has told us, as the presiding officer would attest, that these

requirements and this new authority and the funds to -- for the buyouts and the service credit would allow them to reduce their workforce in the neighborhood of 100,000 employees and saves them $8 billion a year. that is not reflected in the estimate. so i use that example because it shows how strange the scoring is. this is a quirk of the budget scoring rules because when there's a transfer of postal service money -- not taxpayer money, postal service money -- from one account in the treasury, such as the retirement account, into an off-budget

postal operations account, the c.b.o. makes this assumption that savings are not going to occur. so, when you transfer the $11 billion overpayment, the refund, from the pension account to which the postal service has been overcharged into a postal operating account, it gets credited as $5.5 billion instead of $11 billion. that means an on-budget account loses $11 billion, as c.b.o. looks at it, and the off-budget accounts only gains $5.5 billion. this is very complex because it's so obscure and because, frankly, it's so illogical.

the result is a net score in the unified budget of $5.5 billion, as a cost to the treasury. and that simply not the reality. again, these aren't taxpayer dollars. -- again, these aren't taxpayer dollars that went into the overpayment in the first place. so here we have a provision that's being scored as a $5.5 billion cost to the treasury when in fact they aren't tax dollars, and it's only because this is a unified budget where some of the accounts are on-budget, some of the accounts are off-budget that we have this anomalous result. it just doesn't make sense. let me give you another example.

the c.b.o. acknowledges that our reforms of the federal workers' compensation program would save $1.2 billion, but c.b.o. doesn't count this reduction as a savings because of the way that the department of labor charges agencies for participation in the workers' compensation program. again, that just doesn't make any sense when the c.b.o. itself acknowledges that these are real reforms that are going to save $1.2 billion. yet we only get credit for $200 million of the reforms.

mr. president, there's -- there's another issue here. the c.b.o. does not account for what would happen if the postal service allows service to continue to deteriorate. instead, because again the c.b.o. doesn't recognize the reality that all the big mailers and small mailers tell us, which is that revenue will be driven out of the system if the service cuts associated with plant closures and wholesale closures of post offices are allowed to proceed. the bottom line, mr. president, is that were it not for 50% discounts being applied over and over again to the savings that

we achieve for five-day delivery, retiree health care, the pension refund, on the basis of these strange behavioral assumptions and reflecting the odd combination of off-budget and on-budget accounts being brought together in a unified budget, the bill would have scored approximately $24.6 billion more in off-budget savings, making the bill a net saver of $14.8 billion. this is so frustrating, mr. president, because it is so complex. but i think if our colleagues just look at the example of the fers overpayment, it becomes

very clear because there are no taxpayer dollars involved and yet it is scored at -- as a cost to the treasury of $5.5 billion. how can a refund of an overpayment that involved no tax dollars end up being scored as a cost to the treasury of $5.5 billion? that is how illogical and quirky this estimate is, and it is because of the unique status of the postal service and how its various accounts are reflected in the budget. but, mr. president, in addition to my absolute conviction that this score is very misleading,

let me make another point, and that is, if we do not proceed with this bill, if this budget point of order brings down this bill, the postal service will not survive as we know it. and, again, we are not providing a taxpayer subsidy in this bill. in fact, i would argue we're preventing a taxpayer bailout in this bill because later this year, if the postal service cannot meet its payroll and, thus, is unable to deliver mail, i think the pressure for the taxpayer bailout will increase substantially. and i do not want to see us

return to the pre-1971 era where the taxpayers were on the hook for the postal service. and our bill would avoid that and our bill would avoid that

according to the treasury department of social security and of medicare financial status report, the social security trust fund retiree is in the disabilities will run dry and

2033. three years earlier than projected last year. this is 30 minutes. >> good afternoon it will come to my fellow trustees to the treasury and i want to take this opportunity to thank pediatrics aires steve and brick foster and other staff for all their hard work on these reports. every year as you know the social security and medicare boards of trustees issue reports to congress on the strength of these indispensable programs and we just met to complete this year's financial review and to transmit the final reports. millions of americans rely on social security and medicare for health care and millions more will do so in the future and he.

we need to commit to the american people for years to come. but with these reports also reinforce is the we must take steps to keep these programs whole for the future. pressures on these programs are mounting. americans are living longer and a number of retirees are growing. the reports project that we considered a combined basis, social security retirement and disability programs have dedicated funds sufficient to cover benefits over the next 20 years. but in 2033, incoming revenues and the trust fund resources will be insufficient to maintain the payment of full benefits. and after that time dedicated funds will be sufficient to governor that three-quarters of full benefits. the same year as was projected

in last year's report. there's somewhat more pessimistic than last year's projections for the combined social security disability trust funds, the 75 year actuarial in balance is up four tenths of a percentage point. this is in large part due to the trustees' assumptions on the lower wages over the 75 year projection period. with regard to medicare the projected actuarial in balance of the trust fund has increased by six tenths of a percentage point due to the changes in cost production methods recommended by the 2010 or the 2011 medicare technical review panel. while is very substantial nonetheless these reports emphasized the importance of building a consensus on reforms

that would put them on a sound financial footing for the future they give the most significant retirement reform in decades and that law includes measures to strengthen medicare by running in health care cost growth and we need to preserve medicare and the act fully and effectively but more needs to be done and that's what the president has put forth a detailed plan to further reform and strengthen medicare. to achieve the same savings as the bipartisan plan proposed by some symbols recommended. with new incentives for the doctors and hospitals eliminating excess subsidies to the prescription drug companies and asking the very wealthiest seniors to pay a little more.

the president has also committed to protecting social security strong for the future generations particularly as more private employers move away from the defined benefit plans. in the state of the union address last year the president outlined a set of principles reform. the principles emphasize the importance of finding a bipartisan solution that strengthens social security and doesn't hurt the current recipients, doesn't slash benefits for retirees or tie the program to the stock market. as we work to strengthen social security and medicare it is critical that the reforms are slowly phased in over times so the current beneficiaries are not affected and so that future beneficiaries are not experienced precipitous changes. medicare must be balanced and even-handed. we will not support the proposal to the destruction in the name of reform or shift the cost of health care to seniors does seem

tax cuts for the most fortunate of americans. social secure and medicare are the twin pillars of retirement in this country. they are us president obama said expressions of the fact that we are one nation. these programs that are rooted in a basic american census and responsibility have been supportive across both political parties and both democratic and republican administrations. thank you and i'm going to turn over to my colleague and former trustees kathleen sebelius. >> well, thank you, secretary geithner. today's trusty report confirms that medicare is in a stronger position than a was a few years ago thanks to the affordable care act. without the health care law, the hospital insurance trust fund would be exhausted in 2016, just four years from now but as a result of the law, we've added another eight years to its life putting medicare on much more

solid ground. of the law does this through a range of reforms cracking down on fraud to the medical errors to reducing excess payments to the medicare advantage. the report today shows the first wave of reforms will save medicare more than $200 billion by 2016 while also lowering the cost for americans with traditional medicare by nearly $60 billion. that's real money in people's pockets. in addition, the report describes reforms until all that could lead to bigger savings on the road. bye addressing the misaligned incentives that are major drivers of the rising medicare costs. we know that many leading health systems that reduce costs by improving care. for example by managing care more effectively for patients with chronic conditions to keep them healthy year and all of the hospital.

but in the past from the medicare payment structure has made it difficult for providers to provide that kind of care. the health care law begins to break down the barriers with new reforms that free doctors and nurses can deliver high quality and more efficient care. though these incentives are just in the beginning phases, we are confident they will improve care and save money and that means it's very possible in the long run will stabilize the finances in the report today indicates. still, as secretary geithner said, more work remains to be done. today's report shows that medicare per enrollee spending will continue to grow at a slower pace than the private insurance industry. again, thanks in part to the health care law. but it also shows overall medicare costs will continue to grow because the aging population and that's why

secretary geithner noted the president has put forward a budget that builds and expands on the reforms in the affordable care wracked by doing even more to cut waste and fraud, reduce unnecessary payments and help providers deliver more efficient care. unlike some of the of the plans that have been put forward to of this is an approach the but put medicare on a stable trajectory without eliminating the guaranteed benefits of the beneficiaries of count on for decades or shifting the cost on to seniors. it's an approach that makes sure strong medicare is there for our children and grandchildren. today's report shows this approach can work and also makes it clear how important is that we continue to implement the reforms in the health care law get the president's budget to secure the promise of medicare for generations to come.

>> good afternoon everyone and thanks for joining. we've heard about the long-term financial future of social security and medicare. the program serve as a critical lifeline for millions of americans especially for those experiencing these tough economic times. today close to 54 million americans receive social security benefits that includes 38 million retirees, 10 million americans with disabilities and 6 million survivors of deceased workers. social security also serves as a critical one combating poverty in this country. in fact is estimated that the social security payments were excluded from income the number of older people in poverty would increase buy almost 14 million individuals to recover court challenges remain for social security and medicare and thus the retirement of many americans who depend on the benefits they provide. psychiatry geithner and sebelius stress the legislative actions to address these challenges. we know the costs for both

programs are continued to increase due to the continued retirement by the baby boom generation in the lower birth rate. people are also living longer and the cost of health care per beneficiary as continued to rise especially in private health insurance but also for the public programs. reducing the long-term cost of medicare will depend largely on provisions of the affordable care act which will take effect in the coming years. that's one reason why ensuring the successful implementation of the health care law is so important. but there are other important steps that strengthen the sovereignty of the medicare trust fund. critical to this effort is the continued and sustained economic recovery. in the past 25 months the economy has generated 4 million jobs, lead off to those in six levels and the unemployment rate has decreased from the peak of 10% at the height of the recession to 8.4 today. we've made steady progress but

we are not all of the woods yet. we have to make every person and every community for writing again putting more people back to work now crucial to the social security and medicare trust fund. when more people are working on the payroll tax base and so to the trust funds people are able to contribute to them so we are taking concrete steps to put people back on the job and a quicker more effective way. the recent extension of the unemployment insurance and the important reforms that come along with our critical to this effort in providing the services and more flexibility returning to the unemployment system into a reemployment system. making it easier for people to get back to work we are funding the job-training initiatives to focus on making sure the skills workers gain in the classroom is what employers are looking for in the office or the factory floor. in addition of the past two years we worked strategically to incentivize the businesses to put more people back to work.

we also continue to support policies and encourage disabled and older workers to stay on the job. this effort also helps to address the solvency of the trust fund. many disabled workers can and do want to work, so we have to help them do just that as quick as they can. we put forth of the number of initiatives to speed up medical recovery to get folks off this disability insurance and back on the job. ..

>> it should be a model for all of us in washington. having them on board has made an enormous difference in areas ranging from techniques of

economic analysis to language. speaking of continua lead, it is time for congress to take on the task of retooling social security for the long haul. this year's three-year movement on the exhaustion date for the oas di trust fund makes legislative action more critical than ever. congress must congress must begin the process of deciding what levels of benefits and taxation best serves the interests of younger america, who are increasingly uncertain as to whether they can count on social security. it is also now vital for congress to consider reallocating assets between the trust funds, so that disabled americans do not have to fear reductions of benefits in 2016. finally, as in the past, i want to urge you in the media not to complicate congress has responsibilities.

please, please remember that exhaustion is an actuarial term of ours, and it does not mean that there will be no money left to pay any benefits. after 2033, even if congress does nothing, they will still be sufficient assets to pay 75% of the current level of benefits. it is not acceptable, but it is still a fact that there will be assets there. i also want you to know that this year's change in the disability insurance trust fund, as with last year, is due entirely to demographics and the recession. in the past year, there have been reports to the contrary, and i urge you not to repeat that reporting. we need the debate to begin and we needed to be civil and fact-based. clear and accurate reporting on the complexities is essential to that debate. to wrap up, this is the six trustees report i have signed. more than any other commissioner

, and i would be remiss if i concluded my remarks without telling you what you meant us to leverage it has been to serve as a trustee. thank you. >> the social security and medicare programs remain among the more remarkable legislative achievements in american history. these two programs have provided critical insurance protections for hundreds of millions of americans. they have done it at exceptionally low costs, and they have done it with financing methods that while they have their critics, have been generally accepted by most of the american public as equitable, historically. it is important to remember these achievements as we review this year's projections. closer -- both social security and medicare took a turn for the worse this year. with the passage of time,

further passages and constrains take place. as we review our options, the continued strength of these programs depends not only upon finances being restored to balance, but this is done in such a way that the public continues to believe it is reasonably fair. as time continues to pass and as program finances become more strained, this becomes more difficult to achieve. before getting to the specific numbers about social security, i would like to note some general differences between social security and medicare projections. social security does not tend to have large swings in its outlook from year to year. this is because the demographics that guide the finances have been relatively well known for some time. i do care, on hand, this is greater uncertainty because factors like health care cost inflation are inherently more difficult to predict. my colleague will talk about the medicare side, where we have had some offsetting projection

changes in the short-term, some positives and negatives. on the social security side, by contrast, most of the variables lined up on the negative side. as a result on the social security side, both short-term and long-term outlook are wars somewhere. social security's actuarial imbalance. that is a term of ours. that is the tax base and more courageous. that is a 0.44. were sitting relative to last year. that may not seem like a big initiative, but this is now the largest actuarial deficit we have seen in social security since the 1983 reforms. this is the second largest single year deterioration that we have seen in all of the trustees report sends the last major reform. the projected depletion rate is now interested to be -- anticipated to be 2033.

we have lost some ground, not only because the passage of time and legislative inaction, but also because program finances are weaker than we had previously projected. in fact, the 2033 date is the earliest projected by the trustees in more than a decade of reports, and there were a few trustees reports in the mid- 1990s that saw trust fund depletion happening earlier, but we have to remember that now it is much later in the game. as a result, since the 1983 reforms never have become as close to the point of depletion as we are right now. twenty-one years off my might sound like a long way. but given the magnitude, it is not. our window for dealing with it without substantially disruptive consequences is closing rapidly. in 2033, as has been said, we would have enough revenue coming in to pay 75% of scheduled benefits or the payroll tax would have to be raised from 12.4% to 16.7%.

now from about 25% benefit reduction, one must bear in mind that as soon as we would be willing to cut benefits enrolled, including people receiving benefits today. when you factor into account the sheer desire on the part of many policymakers to shield people receiving benefits from changes and low income recipients from benefit reductions, it is clear that we don't have a great deal of time to resolve the imbalance in a way that people on both sides of the aisle will find acceptable. our greatest immediate concern is that we have the fact that the disability insurance trust fund is now projected for 2016. that is the earliest of the different trust fund for we report on. one option for dealing with this is to reallocate tax rates between the disability and retirement sides of social security. we have to remember, of course, will which were up disability. only with the other trust fund. if we want to avoid weakening the other side, we would have to make some tough choices.

we would have to otherwise decrease disability benefits or increase disability taxes, considerably and fairly soon. we would have to find $30 billion of savings annually within the disability programs starting within five years to prevent insolvency. in light of mr.'s reports, it shows a decline of social security finances. this is because of updated economic data. we had a larger than expected social security toll this year. we had workable taxes earnings. this affects our projections for 2012, 2013 and beyond. we have also modified our expectations for long-term changes to worker hours to better fit historical data in an age population. beyond this, we have the usual grab bag. we have the usual effect of the passage of time. we have also incorporated some updated birthrate data. unfortunately, this year, all of

the small factors lined up on the negative side of the line. that is the usual for social security reports. but it is the reality that there could be problems are growing somewhat more serious. insolvency is drawing closer. even accounting for all the sources of income, including funds from recently, the trust fund is lower than projected to further decline. the shortfalls ahead are much larger now than can be readily corrected at the last minute as we have done in 1983. bipartisan action needs to be responsible, decisive, and prompt. thank you. >> good afternoon. being the last of the six trustees to speak, i will be very brief. the primary responsibility of the public trustees is to assure the american public that the

financial and actuarial analysis contained in the trustees reports are as objective as possible. but they use the best available data and information, and they employ the most appropriate methodologies. i think i can speak for all as well as myself, that we can provide that assurance with confidence to the american public. once again, we have participated in an open robust and vibrant discussion of the numerous issues that must be resolved when these two reports are put together. once again, we have been impressed by the expertise and commitment to objectivity of the actuaries and their staff. the stats that support the trustees and the status of the social security administration. mr. we also benefited from the recommendations of two panels. the medical -- dedicate

technical panel and social security technical panel. we have incorporated some but not all of the recommendations in these trustees reports. we intend to continue to draw on these panels insights as we develop future reports. let me make a few observations now that relate to the content of these reports. first, i want to add my voice to the chorus that has emphasized that under current law, both of these vitally important programs are on unsustainable paths. the sooner the policymakers address these challenges, the less disruptive the unavoidable adjustments will be for individuals and for the economy. and the greater the likelihood that the solutions that we adopt will be balanced and equitable. the bottom line message of the 2012 reports differ little from those of previous reports. it is important to realize that

the projections contained in these reports, as others have emphasized, include a lot of uncertainty. this is particularly true with respect to the medicare report, in which the current law projections that are the basis of this report, assume that payments in the physician fee schedule will be cut by 30.9% at the start of 2013 to comply with the sustainable growth rate mechanism. it is almost certain that lawmakers will override this reduction and that medicare part b. expenditures will therefore be higher. conceivably as much as 12% higher than is reported in these reports for 2013. over the long run, the challenge will be the discipline of the affordable care act, which will require significant transportations of the delivery

systems. the ability of providers to improve their productivity. and the willingness of employers, unions, and other payers of private policies to join forces with medicare to demand change. even with the unified and concerted effort, further major legislative changes above and beyond the affordable care act will be required to put medicare on a sustainable path. let me close by saying that as someone who has spent an hour yesterday upon for medicare because i have stepped down after 12 years as president of the urban institute, i have a great instant interest for medicare beneficiaries and social security beneficiaries. >> thank you. we would be happy to take a few questions. >> what is the administration's

plan to turn with the funds? >> congress face this problem back in 1994 with less time to act. they acted than with a tempered solution. i think our judgment is the best way to -- to do a long-term solution. we will be working with that with congress. >> [inaudible question] secretary, i'm curious, in this report and mother are some questions raised by trustees and by rick foster about what the protections will come to pass regarding the verb object. do your makeup, and the significance of these projections -- what does it mean that there is some shadow hanging over us an important report? >> well, that there has been traditionally reluctance among congress to adopt payment

reforms. medicare advantage is a great example. it was started with an intention about medicare fee-for-service as a way to encourage competition in the marketplace. fifteen years later, we were still paying at the passage of the affordable care act 114% of the fee-for-service, in spite of the fact that people kept saying that that needs to be lawyer. the affordable care act custom map. in the last two years, medicare advantage plans are now being paid at a rate of 107% higher, not 114% higher. we are on track to get to parity with the poor service. but we are assuming that the payment reductions, including in the affordable care act, will indeed be carried out if congress chooses to add additional funding. if they do that, then we have to

make different assumptions. but i think skepticism is because often congress has intervened at times where there has been challenges about lowering costs, and kept costs at a higher rate than medpac or others. >> the medicare advantage program is wasting over a billion dollars in taxpayer money. any question about it a js has a legal response? >> as i have just told lester, the good news is that we have medicare advantage -- in spite of all the allegations that somehow the affordable care act would destroy the program, it is stronger than ever before. we have more companies for dissipating the plan. for the first time ever, consumers are actually getting information about quality ratings, and we have more beneficiaries migrating to four-star programs than ever

before. even with the demonstration, which is due to expire in 2014, we are on track to reduce the overpayments of medicare advantage. as i said, with the demonstration money included, we have dropped from 114% of the fee-for-service to now 107% of the beeper service. it cut in half the payments to medicare advantage. it is a basic win-win situation. you have lower rates, you have more plans, you have consumer information for the first time of quality programs, and we are on track to reduce the overpayments, which is substantially saving money in the long haul. >> i'm happy to have secretary geithner answer. [laughter] >> do you plan to let.

[inaudible] run out and provide bonuses? >> we plan to let it run out. our goal is not to give consumers information only, but to measure quality for the first time as opposed to just having a pro- liberty of plans available, often confusing to beneficiaries about the differences in what they are. we think this is an important step. we are pleased to see that more beneficiaries are migrating to the higher rated plans. and we think at the end of 2014 it will have accomplished just what the goal was, which is to give some financial incentives to those plans who are improving quality results. as you know, one of the most discouraging factors around medicare advantage, not only were those plans being paid, 14% more than fee-for-service, and 75% of the beneficiaries were picking up an additional cost is the cost was spread. there was no increased health outcome as a result of that

overpayment. we think this demonstration was important to inform consumers. we intend to keep the quality system in place. not the additional incentives, but again, medicare advantage rates are down substantially over where they were when the president, two years ago, signed the affordable care act. >> [inaudible question] >> thank you all for coming. [inaudible conversations] >> you are watching c-span 2 with politics and public affairs. weekdays featuring live coverage of the u.s. senate. on weekdays and weeknights, watch key public policy events. on weekends watch "book tv." you can join in the conversation on social media sites.

>> tomorrow morning on "washington journal", a look at the treasury department's report on medicare and social security. then we hear from daniel stein, of the federation for american immigration reform. we previewed the supreme court's oral argument over arizona's immigration law. "washington post" geeks takes your calls and e-mails here on c-span. >> one day before the supreme court hears arguments on immigration laws, the senate held a hearing on constitutionality of the immigration laws.

see it live starting at 10:00 a.m. eastern on c-span 3. >> special counsel to president nixon, he plead guilty for his role in watergate. he later became an evangelical preacher. he died earlier this week. >> he had the right, although he abused it, not a lot. nixon told him that because it was regarding foreign policy issues. feel free to come in and interrupt him. henry would do it for it trivial reasons. one they nixon was very ticked off at him for a variety of things. the executive office building,

the far door was open. a consequence of henry. nixon did not appear to work, but i know that he knew it was henry. then he said, you are right about that, chuck. it is time that we use nuclear weapons. kissinger looked absolutely paralyzed. [laughter] colson did bring up the dark side. it was pure humor. nixon loved it. >> care more about his political career, watergate, and this book on prison reform at the c-span video library online. a quarter century politics and public affairs available on your computer anytime. >> the u.s. general overseeing operations in southwest afghanistan, says that he has had no cooperation from the pakistani army in securing the border with afghanistan.

brigadier general, u.s. marine corps john toolan jr. spoke in washington d.c. we pick up with the question-and-answer portion of john toolan jr.'s's remarks. >> i will ask one question, and then look to the audience for the discussion. can you talk more about the taliban and where they are in your estimation, what is the champ dashed chances of them popping up? can you give us a feel for where they are politically and militarily in your view? >> i think the taliban is always going to be, i believe a hard-core element that is going to want to install sharia law. i've seen some of those folks, and i've actually had the opportunity to speak with them.

it is a hard-core radical leap that this is the way it needs to operate. how to reduce that, i am not exactly sure. but i think that they will continue to. they are operating on the other side of the border. the quarter has been a safe haven for sharia leadership. as long as i've been there. we have tried in numerous ways to engage the pakistani army on the border. and talk with them, in my case, to pakistan. it least, put pressure and not make it easy for them to cross the border. it is going on. that is where the taliban is operating. the reintegration of reconciliation program under general allen is encouraging.

he has been encouraging commanders to use that program. it is focused on the mid-level and lower-level taliban. really, the mid-level has been our objective. those are the ones that i just mentioned earlier. if you look at the mid-level taliban, their residence of kandahar, they come from districts, in many cases, they turned taliban because the leadership at the local level at the time was abusive and totalitarian. it was a totalitarian government. what we are seeing now is they are wanting to come back into the. [inaudible] it is always results in making some progress. the taliban will exist -- there will always be -- i don't understand it, but there will always be people willing to kill themselves to put a suicide vest on or drive a suicide vehicle.

they abuse that. you see the taliban abuse that. but i think that there will always be people who are willing to conduct that kind of business. we just need to always make sure that we maintain our guard. >> i will leave it there. >> any questions from the audience? >> [inaudible question] hi, general, my name is gretchen peters. if you could describe the nature of the enemy and the communication. in a lot of areas it seems that the groups that they are fighting seem to be as much criminal organizations, drug trafficking networks, and another category that i will loosely described as young men

being stupid. whether they are actually formally connected to the taliban other than paying tax to them or protection money, that's a question that i have. >> that's a very good question. the nature of the enemy varies upon where you are. if you are in the south, without , as i've explained, the taliban is completely on your back. they are not operating on southern places. we use the analogy that they are on their knees. they are still getting support funding him and i could talk in more detail, but they are still getting funding through some of the criminal patriot networks that are fueling insurgent activity. places like.

[inaudible] , which really today is the most kinetic excerpt in afghanistan. it has changed radically over the past year due to some of the things we did this year. so there is still some taliban insurgent activity there. in the upper helmand valley, places like certain cities, places like that, the taliban are on their heels because we recently -- it was really the last piece of real estate we cleared. they are on the hills, but behind them is the transit area for drugs that is owned by a friend that i mentioned earlier. [inaudible] in his voice. at this stage, we are no longer

in the business of clearing real estate. it is now the afghans providing security. from south to north, it has increased taliban involvement and taliban funding and etc. you are absolutely right. there are a lot of local nationals who get themselves into trouble. to give an opportunity to make a few dollars by planting an ied. they're really not taliban, they are people that were employed at other options, if you look at the elders and other responsible people, and you look at helmand province, we've got to support the local nationals. and it's building.

>> you said you tried to engage the army on the other side. what success have any of you had in getting them to help interdict materials, materials, and other things. >> from ice perspective -- from mice was -- from my perspective, i have had no support. we have tried to conduct operations and discussions, conferences, and there always seems to be something that interferes with that. it is an area that i know my boss at the time, general allen, and general was my commander, had been working very hard at. but it is difficult to seven and

helmand provinces have afghanistan and pakistan as their borders. a long way away from the helmand river valley. in order to provide forces down here to interdict and stop that, it just detracts and takes away from efforts. if i had the pakistani army support to lee's conduct patrols along the border and limit the amount of movement across, it would really help. that's been my focus, but i haven't been able to get that kind of support. >> just another example of how critical pakistan is to us. >> general, a couple of

questions. first, you mentioned that it is important to sideline those you were referring to who is a senator now. how do you think it is most effective way to do that, and how difficult do you think it will be for the nsf and the remaining coalition forces in helmand to maintain those progress points that you described in september when there will be a significant number of millions that will be withdrawn at that point. >> there are two parts to that question. first, [inaudible name] is an individual who has large, financial investment in helmand province. a lot of it comes through the drug trade.

he's got his hands all over it. the only real way of changing his impact -- it's two ways. the first is we have to do a better job of working the narcotic addiction units, which are very good at teaching the narcotic suite and the government of afghanistan. things which are challenging for the afghans, but they are getting better at it. things like collecting evidence and doing criminal investigations. it's got to move parallel to the operations to legitimate criminal investigations. using the rule of law to uphold these people accountable.

we are making progress, but it is really only put in the past year that are narcotics unit have been effective in collecting evidence. that has curtailed the activity and the cronies. it has curtailed activity. that is a good thing. i think it's going to pay dividends later on. the other thing that i think is really vitally important is that the central government has to particularly, people like [inaudible name] who have influence over the government officials, who are now in the process, inappropriately, of appointing leaders in the various districts and provinces. they do say, okay, i'm going to pull this governor out because in one city, for example, this

gentleman is not doing what i'm asking him to do. all of a sudden, somebody comes in and here comes the district governor. it is because they have influenced the decision process. the constitution of afghanistan, if you read it, it is very similar to what the united states looks at -- passing control to the states, plus powerful central government. what we are seeing right now and in afghanistan, it has not been fully enacted. at the district and local levels were though elections show some progress. particularly in helmand. we have had some good success in helmand. the federal government doesn't trust the local leadership. they want to appoint their own

governors. i have had three chiefs of police in helmand. you build the trust of one, he pulls out. he is not doing what he's told to do. someone asked if the mayor. what we really need to do is stop the central government's meddling in the local politics. the only way you will make a difference in afghanistan is to allow the local districts and provinces to control their own fates. fate. but there isn't that degree of faith yet in the central government. you don't feel comfortable in doing that yet. it's going to come, but that is how, i think, limit the impact of the senior-level influence -- negative influencers on afghanistan in helmand province. the second part of your question is a lot more important, and

certainly something that at the provincial level can impact. that is how do we support the afghan national security forces in maintaining stability and maintaining control in the province. first of all, you would be amazed at the wonderful, strong relationships that everybody from psc two kernel have built with the afghan security forces. when i left, i would've thought that i was leaving my family. it was a very moving experience. after a year of sharing hardships, explosions, casualties, elections, all the good things we have built a very strong bond.

that needs to continue. honestly, there is the rest of that. as you know, we have had to deal with some of the insider threats that exist in afghanistan. if you would believe -- the media that maybe plays of these instances greater than they really are, i think for everyone inside a thread issue, there are 100 events that are created to create a strong bond. that is the key is to keep the bond with the afghan national security forces and their trust and faith and they will stand up for their own. >> thank you general, for that good answer. yes, in the back? >> thank you so much. i'm from the washington times.

general, u.s. troops are expected to consolidate in the south and focus more on the east. as far as you know, what consolidation will look like -- can you talk about that what it will look like and what you expect for the spring planting season and do you expect that we will be able to hold gains that we have made in the south. thank you. >> are good questions. i have worked very hard over the past year to convince my leaders that the insurgency is the greatest threat to the government of afghanistan. if it should strengthen, that will provide a greater threat for the greatest threat to the afghan government. i say that because currently the south is the main effort. the preponderance of resources

is in the south. we need to maintain the pressure that i was just speaking about. we need to maintain it in the south. we can't let it up. as we are joined their and our forces, we are drying up afghan national security forces capabilities to capacity and get the numbers up. and most important way, there will. those three elements of afghan security forces are on the rise. somewhere in the middle, is the sweet spot. i think we are there. but we don't want to do is change that main effort until after this season. now, i don't like using the term fighting season because i think, and to my commanders, we don't

say fighting season. it is a little psychosis there. if we use that term, we are giving up the initiatives to the insurgency. we look at it more as a cycle. i think that the recent incident in cabo where we have had some attacks, that are very weak. the afghan national security forces stand up pretty easily. last season during the harvest season, may 17, there was a big published data they were going to come out and it was going to be big. i really do believe that the insurgents cannot introduce any type of complex attack. the most complex that you're going to see is not going to

happen in helmand province. just because they don't have that capability. they don't have leadership. they don't have the capability to orchestrate that kind of attack. and they don't have the capacity because the numbers of insurgents are not the same as they were two years ago. i believe, and we will see very soon, because the harvest is about to begin and it will take about 30 days, i do believe that the afghan national security forces, with their strong capabilities of gathering intelligence at the human level, that it is a very powerful intelligence, and they will know ahead of time. then you combine that with the support of the local nationals, it is going to be very hard for them to swim among the local nationals because, you know, they are not getting the support. i believe, and we will see. if it is correct, what will

happen, and going back to your first question -- as the main effort shifts, the hook on a network has gotten a lot of attention. that number -- it is a network that operates to maintain itself. it doesn't have that grand design. as the insurgency goes, the network does. but if they do operate in other places and that is where they want to shift the main effort too. this post harvest season, we will see. i think what we will find is that we will be able to hold the line and maybe make that shift next year.

thank you, general. in the back? >> i am from al of the fence. having talked to a lot of young officers and off from both wars, address for a moment the young marine leaders that have served with you. they have been doing all this polling, but we are drawing down. the shift to asia, the partnership building, the court is trying to get back to its maritime and expeditionary roots. and, of course, everything is going down. including the number of personnel. two young marine lieutenant or captain were starting today, what you say about why is their experience of the last decade relevant? how are they going to have to adapt?

and why should they stay in when everything is changing radically? >> that's good. i had those kinds of discussions recently. had discussions with a lot of young leaders and marines. i will say that haqqani is a very complex network. the job is done. what we are doing right now in this year is critical to the transition, we are not necessarily changing the mission in afghanistan. but we are changing and walking into the final phase of a counterinsurgency, which is to advise and train and set the indigenous forces up for success. the mission is not changing, but

we have trained or our guys to understand that in a counterinsurgency, you can't win a counterinsurgency with coalition forces. you have to win it with indigenous forces. so that they know that the mission now is to support and backup the afghan security forces. we are following through in that mission, all the way to the end. although 2014 looms out there is being the end of the counterinsurgency, the final phase is the support phase. we haven't really put a descriptor on exactly what is going to be left, but there will be things left after 2014 that will continue to support the afghan security forces. you are absolutely right in the fact that the passengers we have concentrated on the fight in afghanistan and iraq.

there has been a counterinsurgency and it requires different skills of our marines, particularly, i think, we have concentrated on the operations on the ground in iraq and afghanistan, and we having conducted as much amphibious operations as you alluded to in areas that we might be returning to. although, i will say that one of the more successful operations was in 2001 where we did go to afghanistan and remove the personnel and equipment, over 400 miles to afghanistan. there will be some ships. also, too, we will be losing marines and soldiers and sailors who have phd's. they understand it, they get it,

and they are good at it and they like it. they are effective. as we drive down, we will lose some of those guys. but i think what we have learned is that in a counterinsurgency, there are some basic principles that apply across the board. we realize that those fundamentals we can never lose. certainly, as a marine, being an expeditionary force and being able to operate in helmand and nimruz province, it is a big footprint. sometimes it requires a little bit of discipline. to say okay, we are not going to put that in because we don't need it. in fact, let's live over there with the afghans in their facilities. we are doing more and more of that. to get to that expeditionary low footprint mode.

>> we had the news that the u.s. afghan partner agreement, which is a very broad agreement, over the weekend, which as i understand hopefully lead to more specific agreement that is hammered out. hammered out with the afghan government on our military partnership and security relationship. here at the atlantic council, we are looking at the nato summit and in less than a month in chicago, where afghanistan will be one of the most primary agenda item. we have had headlines over the last couple of months of what looks like some key coalition and ally contributors coming out a little bit early. possibly the uk and france and others. the question i have is from your point of view, what sort of a

plan is in place for this transition -- what partners do you see going forward is if you are allowed to discuss that specific, and what is the key strategy, if you can be specific, until the transition in 2014 and afterwards occurs? that is the part we have missed. we have a lot of announcements, but i think more importantly is what is the strategy guiding our footprint and our activity going forward? this is going to have to be a long-term partnership. we are in places like bosnia, many years after the fact. we said sure and only -- we should certainly be able to talk about this and if you have any thoughts, we can take it from here. >> coalition warfare is very difficult. it is even more difficult without coalition forces. the reality is that we need to all learned and be better at

conducting coalition operations. for me, it was a tremendous learning experience as the commander of coalition forces, as many of you know, and i tried to put on the film, we had georgians, jordanians, uae, we had a huge coalition force. when you find the niche, what they contribute best, and you integrated, it makes a difference. it really makes a difference. the challenge for general alan, and he has reminded the regional commanders that there really isn't anything more important than keeping this coalition together throughout this operation until the end. it hurts when a country like france, for example, says that

after an insider event were several soldiers were killed, they say we are out of here. that registers a w. for the insurgency. it is powerful for a coalition partner, when the uk steps up and says, for example, we are here until the end. and by the way, we are not reducing our forces. the uk is only going to reduce their forces by about 500 over the next year. it is very small. that is helpful. that served as a great statement for helmand province for us. the strategic partnership that you referred to in the beginning between afghanistan and the coalition, it has had some challenges. the two big ones are not --

nitrates and retention operations. those are the two big ones. i think the president of afghanistan has been working very hard to cut out night raids. what we have done in order to satisfy that desire by the president is, in effect, we have taken u.s. forces out of the actual conduct of the night raids and put them in advisor training. in helmand province, we were conducting night raids almost every night. we are still doing them. we were doing night raids with commandos. we were doing them with their not chronic addiction unit guys. i mentioned that earlier. in fact, we just had a rate several months ago with the niu, whose advice and trained by a couple of dea agents that were with them.

that is how we are doing the night raids. we are not connecting them anymore, we are just in a supervisory role. as far as retention operations, i think that's the wonder that is going to be the biggest challenge. we have operations that can't and do not fall under the criminal investigative line. it is difficult for us to allow those insurgents to just turn them over to the afghan government. one of the areas that requires continued attention is rule of law. the whole system, from criminal investigation all the way to prosecution and attention. it is working, it's in progress, but is not complete. until that is really established, i think it's

dangerous to turn over operations completely to the afghans. but we are working closely in this strategic partnership, and it is impacted by some of those sensitive issues. >> thank you very much. >> in the front? >> thank you for the great introduction and speech. my question is. [inaudible] [inaudible question] [inaudible question] not from the military level, but from the social lever. do we lose this? do we lose this? >> a good question. unfortunately, in the afghan national army, the percentage of

those serving in a court, which is the core responsible for a southwest region, it is probably less than about 15%. culturally, particularly, those that come out of helmand province, they don't look to the arming order employment. we have been trying hard to bring more into the army. in the 215th corps, two are from the commanders. they are from helmand.

the other is in touch. it would be better if there were more, but really, what we're trying to focus on and our attention on is the afghan uniform please. we realize that if we're going to make a difference, or for going to keep the support of local nationals, the police are the ones that are going to control the populations support and the support them in the helmand river valley. the army, the intent, it is for the army to leave, and we are currently doing that right now. to leave the populated areas and move out into the further regions of helmand and numerous provinces. so that their focus becomes the borders and the police focus becomes the populated centers. that's where you find the locals who are taking responsibility for their homes.

it is very interesting, because the average citizen does not want to leave home. americans need to realize that some of these guys are joining the police -- if there is the threat that they might not be able to stay and they might move them to in the south -- they don't want to leave home. we have to understand that and respect that. there is a challenge. home is home. they don't like leaving home. but i think that is what we are trying to do is make sure that they are in the police and the afghan monarchy army moves out of the populated centers. as a mentioned earlier, it is still a work in progress. the police are still working

through a history of corruption. the local people, they are still hesitant. the army is still playing a strong role. they are pretty well respected. we are working through that stage of moving the army out and having the police do more of law enforcement matters than combat operations. that is where the local homegrown people are going to focus their efforts. >> a question in the back? >> good morning, general. i am originally from afghanistan. i worked as a subject matter expert at the university of virginia. welcome back home. it is a very good presentation and very motivational. after long time, we saw good things come home. how do we convince the american

public and 70s images into the american media to convince them to stay committed to to this fight against terrorism. >> that is one of the reasons why i am on the steward here for the next 10 days. to get around and tried to get the word out to a variety of people. .. ..

roads to nowhere, and i wanted to write an article, but you know i was in afghanistan. those roads are critically important. many of the counterinsurgent experts have told you that these insurgencies began and being able to give people jobs and build the value chain and the agricultural industry. that is what it's all about. but the individual marines and thousands and thousands of soldiers and marines and sailors that serve in afghanistan, when they are told and understand the picture, they are our best salesman on what they have accomplished in afghanistan. not to mention the fact that obviously, i mean statistics in connecticut reduction in percentage, i can give you all of those and its dramatic. it's impressive when you look at

what was going on and what the news media called the festering sore of afghanistan. you saw pictures of marjah. is a bustling area. i brought congressmencongressmen, senators, anybody. i brought them right there to the market square was no armor are nothing. so, i mean, these stories just need to come back. but i also understand that we are sensitive to the fact that the individual's marines and soldiers are sensitive to the fact that they have got to maintain the highest levels of standards in afghanistan because the impact of negative press, the impact of you know, a marine or a soldier being shot by an afghan soldier or police officer has a powerful impact and it could be 100 great stories in

one, so again, i think it's a matter of us one, make sure we maintain and keep our honor clean and maintain the high standards are as we are operating in afghanistan afghanistan and when we come back, that we are informed enough to be able to explain to people that hey you know we really did make some great progress, and i think that will probably be worth it. here's the bottom line for me though. there has been a lot of sacrifices made in afghanistan and iran. in helmand province for example, the casualties for u.s. forces has dropped dramatically, but the casualties on the afghan side has increased dramatically. it shows the fact that yes the afghans are now in the lead in

many of the districts and they are responsible for the security, but those sacrifices are important as we owe both the afghan and the coalition forces, we owe it to them to make sure we stay the course as we are making great arborist. it's not perfect. we tried to bring up some of the hiccups but it's on track and it's moving. and so hopefully between the discussions that we have and others, we will get some supporters to stay the course. >> we have time for one more question. >> thank you. roger kirk, atlanta council. my question is, what kind of training and support do you expect we will need after 2014, and what are the prospects you see a fat? >> i think there are some areas

that the afghans will not be able to build capability or capacity over the next two years and so they are going to need our support. as i mentioned earlier the afghans are human intelligence, nobody is better than they are so that is really a powerful resource. but they don't have the rest of the intelligence capabilities. they don't have the recognizance that we have which by the way have grown exponentially in the battlefield and i am a very happy commander with what we are getting out there. the afghans know now that we have that and they want to maintain or have access, so i think we'll have to provide that for a while, passed 2014. there is no medical support capability anywhere in the world

better than we have in the world and nowhere on the battlefield was a casualty without support for less than an hour. we can get a guy stabilized into the hospital and just amazing support. we have been providing that support for the afghans army and police, and quite honestly for many of the locals, local nationals will try that support. that is something that the afghans know that they are going to have to provide at least some level of care. won't be like but we have, but that will take time so we are going to have to stay there and provide medevac and medical care. we are doing some great work. not only is the advising training tactics and security operations but every member of my staff was advising somewhere.

my best surgeon was working with their doctors. so that is going to have to continue. i think fire support is an area that again will have to be maintained between 14. they don't really have the capability to put two rounds on target and be absolutely precise, like we can. and it makes your ice water to see how precise our fire support systems are, and the afghans know that. a bomb could exacerbate the whole problem again so that is going to have to stick around for while. that is a little more complicated because as we lose eyeballs on the battlefield we have to find a way to ensure that when the afghans call for fire or need fire support, that we have some way of seeing it.

and so one of the things that we are developing, particularly in the rc-southwest, is full motion video so that his belief places, we are maintaining systems. we have balloons. we have various kinds of looking devices that we have integrated, which will allow us to provide instantaneous or near instant support for the afghans when they call for fire. so i think you know, those are three areas. probably the one area that is the most delicate is that we have been working with the police and as i mentioned earlier that police are the center of gravity. they are the ones that are really going to win this thing for the duration. we dabble in criminal investigations and evidence collection, and we have to stop dabbling and we need to get the experts in there. we need to bring in the law enforcement experts. very similar to what we did in bosnia when we brought in police

forces from all over, nato, so if i was there to force generation nato i would be looking to build up that capability for the long-haul. and then lastly, we have made humongous improvements in the integration special operations forces, the conventional forces to the point where it's almost seamless now. is the conventional forces leave, special operations forces will be continue to be required because they're special operations capabilities are going to take a little bit longer to nurture and mature and those special operations forces will have to be there to back them up. >> well general unfortunately her time is up. i have another 10 questions but i'm sure the audience has as well but our time is that. thank you so much for coming here and telling us this very

important story for our country and for our allies and certainly for afghanistan and partners and thank you most of all for your service to the country and for the effort. [applause]

>> one of the things that i always remember because my office overlooks the building in the plaza was the plaza, there was a center of the plaza and some of the children were killed and others injured but during their recess. met they would always come play out here on the plaza and you would hear their voices. so that left a lasting impression of course when they were silenced. my son, different of his in high school, she had just graduated

and was working in the social security office. her father was a good friend of mine and when i got home actually that morning i had three different messages. first of all wanting to know what he could find out about his daughter and secondly the third message was when he was crying. >> iraq's crude oil exports from southern oil terminals have jumped to record rates this month and are expected to remain consistent this year. at the state department monday, u.s. and iraqi officials discussed an agreement on energy policy including oil and electricity. this is 30 minutes.

>> good afternoon everyone. welcome to the state department. as you now today, monday april 23, the united states and the government of iraq held the inaugural meeting of the joint coordinating committee on energy at the department of energy and here to talk about that meeting and some of the issues raised there, we have the iraqi deputy prime minister for energy, dr. hussein al shahristani as well as our special envoy and coordinator for international energy affairs, ambassador carlos pascual and of course deputy secretary of the department of energy, dan poneman so without further ado i will let ambassador pascual take the mic. >> good afternoon. it's a pleasure to see you and our behalf of the state department and the department of energy let me judy hsu to the joint quiddity committee on energy. is reflective of the relationship between the united states in iraq and how it has evolved and how we have established mechanisms to be able to work on issues that matter critical for both countries and energy is obviously one of those.

it's fundamental to the rising economic future and fundamental to the ability to generate power for its own people and fundamental to its ability to supply international markets and in that context a direct interest to the united states. we have been working together on how to support iraq's efforts to increase its oil production and indeed iraq's effort has reached a level of about 3 million barrels a day in production. last year the average was about 2.7 million barrels a day in the year before that it was about 2.4 million barrels a day reflective of the consistent increase over time and hence one of the issues we discussed was how to sustain that progress. one of the issues that deputy prime minister al shahristani focused particular attention on was the importance of turning iraq's energy resources into benefits to the iraqi people and that is electricity generation. so we reviewed how to continue to work together on increasing electricity availability and terms of iraq.

our commitment to this joint coordinating committee is a reflection of the all of government approach we have taken. the department of energy and the department state have been sharing together but we have included participants from a range of other entities including the department treasure, department of commerce and our security agencies looking at iraq's energy and infrastructure and through this kind of ongoing mechanism our intent was to be able to reinforce in a consistent the consistent steady way the development of iraq's hydrocarbon resources, lectures of the resources for its people, the environment for international companies to be able to invest in through that the united states would benefit as well. so with that let me ask my colleague, the deputy secretary of energy who has played an absolutely leadership role in the establishment of this joint cordon 80 committee and a leadership role within our government on energy issues, dan poneman to say a few words. >> thank you ambassador. this is a historic moment.

it is a pivotal moment in the transition of the relationship between the united states and iraq. rooted in the 2008 strategic framework agreement. we now see as we have been working for many years with the energy sector move front and center. as many of us joined vice president biden last december when we witness the transition from military dominated relationships into much more formally civilian driven relationship we have been working hard to expand on the cooperation that ambassador pascual is just outlined. the areas of cooperation are wide. the opportunities that we have discussed and we have identified our vast and we have reached a strong convergence of view with our iraqi partners on a path forward. clearly it is centered in the oil and gas sector, as you heard

ambassador pascual note. there have been impressive gains in iraqi oil production in recent years and those gains are set to continue. we have been working hard also in the area of electricity, not only power generation but discussing such widespread issues as demand side management, energy efficiency and even the possibility of developing renewable energy resources in iraq. we have also, what they think great enthusiasm on both sides, talked about the importance of critical infrastructure and protections, and our iraqi colleagues will have a chance further to discuss this as they make their way around the u.s. and talk to other experts in this area. in this connection i would like to note that, as the next age of this cooperation, i am delighted to join deputy prime minister al shahristani and we will be

visiting lawrence livermore national laboratories where we will continue not only discussions about political infrastructures but also on some of the exciting new energy technologies that have so much promise for us all. ambassador pascual said none of this would be possible without tremendous cooperation from the other agencies and of the leadership of the president and vice president, and the secretary of state who have been very clear with us on the importance that they attach to the burgeoning energy relationship between the united states and iraq. it's an area not only a great opportunity but in which we have a clear convergence of interest and as we agreed and our very extensive discussions for the first part of today, we have a very clear sense on both sides and mutually what work we have before us and i think we are all very enthusiastic to embrace that work program. with that i would like to not only thank or state department hosts and ambassador pascual has also been absolutely essential in this effort, but also turn the floor over to her steam

colleague good friend, mr. al shahristani. >> thank you for coming. iraq is called upon to support the world's energy needs in the coming years and it is expected that the world will need more energy, more hydrocarbon energy in the coming two to three decades, and iraq is uniquely positioned to be able to provide the world with its incremental energy needs. that is why we have invited the international oil companies to work with us to develop the iraqi resources and the work has started based on the contracts that they signed two years ago in the production is already

increasing and so are our exports. we have developed infrastructures to enable us to handle more exports to the world market. as we speak, iraq is producing more than 3 million barrels a day of crude oil, but we expect in six years to be able to increase that capacity of production to more than 10 million barrels per day. this is to assure the world market that there is sufficient crude for them. we would like to be considered as a dependable, long-term supplier of world energy needs with oil or gas, and there should not be concerned of shortages in the supply in the

near future. we are extremely happy with our cooperation, with the united states, not only to develop our energy resources but in the general strategic framework agreements and a number of areas. the united states has asked the iraqi people to help them freedom of a dictatorship, to rebuild the country and as we are moving into a more strategic cooperation and in civil areas, we consider the energy sector is one of the most important set there's where the two countries can cooperate to develop and unleash in the short-term but also to look further forward to other sources of energy that,

most delicate sources of energy and iraq. gas also is very important resource. many countries in the region and also in europe are looking towards iraq to be able to provide them with some of their needs. iraq is very much interested to be a partner and a supplier of gas to not only our arab neighbors but also to the european countries and the world at large. we have also discussed cooperation in protecting the iraqi energy infrastructure within onshore or offshore. these cooperations of are also extremely important as we look forward to further cooperation

in other areas. we also have the chance to meet with some american companies who are interested in looking to investment opportunities in iraq. we welcomed them and assure them that iraq with its new policies and investment incentives are coming to international companies, specifically american companies not only in the energy sector but in all of the sectors and the tele committee keeshan sector and housing. there is a great potential over the coming years and we hope that this cooperation -- and the success we have had with oil companies to develop our fields

would he and incentive to the other companies to come and join us in rebuilding iraq. thank you. >> thank you. we have time for a few more questions. if you could give your name and immediate deletion. >> andy quinn from reuters. i will ask if during a discussion of the situation with kyrgyzstan, exxon came up with the current state of players with that particular issue and specifically to the deputy prime minister and exons decisions to freeze its contacts with the krg enough to get it back on the list of prequalified companies for the next round? >> axon being well are just oil company in the world has been among the first companies to sign a contract and we are developing one of the largest

fields in iraq. we have continued to and the progress has gone according to plan. we are discussing with them the concerns that will face iraq when the contracts are signed with the krg. you asked if they will freeze things as they are. we are working with the krg to try to develop a framework to enable all of the companies to be able to work in iraq. >> i would just add, we maintain of course a continuing dialogue with all u.s. companies around the world and that hasn't been set said on the particular

matters before between a company and a government. we don't get in the middle of that discussion. our role as a government is to work with the other government to encourage any issue that may be involving sovereign to be resolved in a matter that is clear and transparent in any due process required for any u.s. companies be offered in the same spirit of the process that we call for companies all across the world. was not specifically part of our jcc agenda. >> how will the lack of it comprehensive agreement affect cooperation between the u.s. and the iraqis? >> well, first of all one of the things which the iraqi side has been consistently working on is to try to find the mechanism to create a hydrocarbon consensus internally within the country so

everybody has clear rules of the road. in the meantime, throughout us to the country mechanisms have been put in place that have allowed companies to be able to make investments and begin production. we have seen that in the south with a significant production increases that have already occurred. we have seen the potential for it in the northern parts of the country, including the kurdish region. there have been disputes and the iraqi government has been very clear about that. we have heard about it from both the krg and the iraqi side in the critical issue that we have been trying to work on from the perspective of the united states government is to play any kind of facilitating role either from technical advice or any other matter that could be held fully useful to the parties but in and it has to be fundamentally an issue that the iraqi parties decide. in the meantime, there is still tremendous potential and opportunity for the development of energy resources within iraq and we have seen that consistently over the past two

years. even as we speak right now, new investments have been put on line that are of allowing for additional export production capacity including a single point mooring mechanism in the second one which is just been opened up and which a ship is actually being loaded. so we look forward to the continued increase of production and export out of iraq but at the same time we are encouraging all of the parties to do everything that they can so that they have clear rules of the road going into the future on how they are able to further develop their hydrocarbon resources. >> go ahead. >> i would just add, of course do have hydrocarbon laws, the key of the issues is important and the iraqi government is pushing forward the legislation of such a law. however, this is has not deterred the oil companies from

signing contracts. they have already succeeded to increase production and to increase exports, and we are trying with the oil companies to sign contracts with us our best to increase iraq's production to significantly higher levels than what we are producing right now. the hydrocarbon law is legislated, the prevailing laws in iraq that have been regulating the energy sector with the oil sector or electricity are enforced until they are changed by new legislation. >> dr. al shahristani dave with argon media. i believe you mentioned 10 million barrels a day within six years. now also if i understand right you have also talked about reducing your alpha capacity

target for 2017 so is 10 million barrels a day and new target that you are contemplating? >> we have engaged the ioc in developing these fields to put our production plan based on best dresser for practices to increase the recoverable oil from these fields. we are also engaged in international consultants to advise us on what are the best production targets for iraq. and we are revising the recommendations. we are reviewing the recommendations that have been made but and before the end of the year iraq will make a decision and announce it as what are the targets for the coming years. but the figure that i mentioned,

about 10 million barrels a day, this is a revised figure. the contracts contract that contracts that have already been signed for the 12 oilfields and the three gas fields, the total of these contracts is about 12 million barrels presently. >> and a couple of questions from me. any other questions? >> i have one for the american participants on iraq. i wonder if he could talk a little bit about whether or not the energy prices make it more likely that future preserves might be tapped and you feel the iran sanctions alone are enough to justify or would an additional market disruption be necessary? >> the president is very clear about this. first of all in reference to prices, i think everyone

including me, who has been to the gas pump understands the pain all americans are feeling and it's hurting families and hurting companies and we are very focused on the current high state of energy prices and they are too high. we have been watching closely, daily the energy markets for disruptions. as the president has made clear we have kept every tool available to us in a state that can be used and we are continually consulting with our international partners on this. we are looking at the whole cluster of factors that contribute to this. the production that has fallen off the market, the demands in the market both pro and con and we are going to keep monitoring those issues. there will not be any single issue. the president has also been clear that the regional tensions related to iran's noncompliance

are unsettling markets and in that respect, the best thing for iran would be to return to full compliance with their international obligations. >> jim michaels, "usa today." dr. al shahristani a question about power generation and electricity. clearly demand is continuing to go up what i'm wondering if you have some projections that when you anticipate a supply will be able to meet demand or close to meeting demand? >> we have already signed to build a new powell -- powerstation with the sort of capacity of 15 gigawatts. some of these new power stations

will be ready this year. some of them during the summer and others before the end of the year. all the new power generation we expect to be connected to the grid before the end of next year, so by then we should have enough generating capacity, the 15,000 in addition to the 9000 we have

>> thanks for all of you for coming today. >> coming up next a hearing on dramatic train injury and treatments. then senators jeff sessions of alabama and susan collins of maine debate efforts to overhaul the u.s. coastal sent -- postal service. after that a hearing looking

into the impact of mobile payments on financial services. that is followed by live coverage of the british inquiry into phone-hacking by news of the world publications. >> one day before the supreme court hears oral arguments on arizona's immigration laws, the senate judiciary committee held a hearing looking into the constitutionality of state

immigration laws. witnesses include the original author of the legislation, arizona state senator russell pierce. see it live starting at 10:00 a.m. eastern on c-span3. >> next hearing on dramatic train injury treatment and research. the house energy and commerce subcommittee on health heard from caretakers and government officials. they described efforts to coordinate tbi programs across various agencies. the centers for disease control and prevention says 1.7 million americans sustain a traumatic brain injury every year. this is an hour and 20 minutes. >> subcommittee will come to order. the chair recognizes himself for five minutes for an opening statement. as many of you know, march is brain injury awareness month. according to the cbc and

estimated 1.7 million people sustained a dramatic train injury each year, and that figure, 1.365 million, or 80%, are treated and released from the emergency room. 275,000 are hospitalized and 52,000 will die. tbi affects everyone. it is not restricted to one race, gender or socioeconomic group. while children age four and under and adults over the age of 75 are particularly at risk, brain injury affects soldiers, athletes and even members of congress like our former colleague, gabby giffords. the annual cost to tbi is estimated at $48 billion, but dollars alone did not paint a complete picture of the scope of these injuries.

it does not take into account the suffering of a person with a brain injury who may be disabled for life or the strain of a loved one's tbi -- a loved one that tbi places on family members who are so often the caregivers. federal efforts to address tbi began with a dramatic brain injury act of 1996. the acting to identify and increase awareness of tbi through new research and programs. that tbi amendments of 2001 and amended in 1996 law by extending the authorization to include the implementation of a national trauma brain injury education and awareness campaign. the germanic train injury after 2008 reauthorize the program and also authorize cdc and nih to conduct a study to examine the information gathered by hhs, assess appropriate interventions and develop practice guidelines. i look forward to the results of

the study which will come out in november of this year. the 2008 act also focused on the incidence and prevalence of tbi, uniform reporting in linking individuals with tbi to support services and academic institutions to conduct research. i would like to hear an assessment from each of our witnesses of these federal programs. what have we learned about the causes, the diagnoses, the treatment of tbi through hhs' epperson how is that knowledge being applied in world war i situations. i would also like to hear their ideas about where we should go from here. i would like to say a special hello to dr. flaura winston from the children's hospital of philadelphia who is a one-stroke role institution it is certainly of my constituents. i would also like to welcome those with us today who have tbi as well as their families and caregivers to make enormous

sacrifices every day. we are glad that you are all here. i yield the balance of my time to the vice chairman,. >> a thank the chairman for the recognition. today's hearing is of vital importance as a center for disease control estimates over 1.5 million people sustained a traumatic brain injury annually and over 52,000 of them do not survive. those that do survive, this makes pediatric brain injury the number one cause of death and disability for children. there exists no viable repair repaired of therapeutic option for patients and all the interventions are designed to prevent progression of the injury or secondary injury. in order to successfully treat traumatic brain injury, health care professionals and researchers with the resources needed to achieve the goal of improving quality of life for those affected. although there are numerous

research projects underway across the country including the university of texas and north texas brain injury model system in tbi center, centralizing research approach that avoids duplication is lacking. a government accountability office report released january entitled psychological health of traumatic brain injury activities emphasize the need for coordination and care and coordination of services and traumatic brain injury and patient in the department of defense. there was no central location to obtain accurate an accurate and timely information on traumatic brain injury and a variety of resources nor to obtain their data. i believe to better coordinate research and support services we need to get it grasp in this hearing is designed to do that on funding of projects that are meant to address traumatic brain injury. h.r. 2600 with lead state senators like the senate for

brain health at the university of texas at dallas the countries the virtual center for pediatric required brain injury to continue benefiting individuals with evidence-based systems of care. additionally the money will be allocated from the available discretionary funds and will be on hand to advance our knowledge of the brain over the next several years. thank you's chairman for the mission and i will you back a time. >> the chair thanks a gentleman and recognizes the rank member of the subcommittee mr. plumb for five minutes for an opening statement. >> today this committee will have the opportunity to hear from some of the leading experts in the germanic brain injury community about an update on the current landscape of traumatic brain injury prevention research and treatment. as we almost traumatic brain injuries are very serious spectrum of diseases that can have devastating outcomes. when i was chairman of the site can second he withheld a field hearing regarding pediatric sports related concussions in new jersey and today i look forward to an informative hearing it takes a broader perspective on this critical

issue. according to the cdc over 1.7 million people are subjected to a traumatic brain injury each year. for the more germanic brain injury accounts for one third of all injury related deaths. the statistics only tell part of the story and currently it's unclear how many people are misdiagnosed or don't receive treatment after a traumatic brain injury. traumatic brain injury affects many sectors of our population. these entries contain to play -- my plague our young people and elderly, some of the most vulnerable numbers of sires the. it has a non-impact on our military and the sports community. edition i would be remiss as my chairman said if i didn't mention how a member of our own body was a victim of performing her congressional duties. constantly there must -- it's my understanding that the overwhelming majority of people that suffer a dramatic brain

injury did not die from their injuries however that also means patients are a risk of developing long-term complications that can develop from mild traumatic brain injury. patients who suffer from cognitive impairments like memory loss, impaired communications, mental illness, epilepsy and are even at risk of developing parkinson's disease or alzheimer's disease. these complications can create devastating disabilities and hinder an individual's productivity. we also created tremendous emotional and financial burden to families and society as a whole, ensuring that these patients have access to innovative and vital treatments and social services is a great challenge we must all work together to achieve. since the passage of the traumatic brain injury act of 1996 and subsequent reauthorization, several federal agencies have led efforts to understand, prevent and treat dramatic brain injury. most recently these efforts have undergone formal ordination data inter-agency commission.

this committee which includes hhs agencies and non-hhs agencies will hopefully excel are great and coordinate initiatives and i look forward to hearing more about the proposed plans and it gives. i would also like to highlight the importance of partnerships with the states in addressing this important cause. i greatly appreciate the presence of william ditto who hails from the great state of new jersey. mr. ditto is the director of the brain injury program and represents the national association of state head and district -- head injury administrators. mr. ditto along with with the his colleagues have made great strides in leveraging their limited federal and state funds to coordinate and provide services for individuals with traumatic brain injury. strengthening partnerships like these will improve the outcomes of the families and patients affected by germanic brain injury. i look forward to today's testimony and mr. chairman i would like to ask as i think you know congressman my colleague

from new jersey has been a leader on this whole issue and i know he is not a member of the committee but he asked if i could die unanimous consent and i will ask unanimous consent to include a statement for the record. spew without objection, so order. >> thank you mr. chairman and as i said i look forward to the testimony and i appreciate you holding a hearing hearing today. savannah recognize mr. upton for five minutes for an opening statement. >> thank you mr. chairman. according to a recent report from from the cdc at least 1.7 million folk sustain a traumatic brain injury every year. we don't have to look far to see the profound effects of a major tbi. children injured by caretakers are car accidents, athletes and pair by multiple concussions or soldiers disabled for more and one of our colleagues at a constituent event in arizona lesser. the department of veterans affairs and the department of

defense and several agencies of the hhs is incumbent upon us to examine these activities so they can work and be coordinated in an efficient manner and i i a producer from the congressional brain injury task forc and encourage bipartisan support for tbi resech rehabilitation and with that support i'm confident we will make greater strides to help patients living with the aftermath of tbi. i want to extend a warm welcome to families attending today's hearing is part of brain injury awareness month and i look forward to your testimony and i yield back to the chairman. >> the chair thanks the gentleman. today we have four witnesses on our panel. dr. bonnie strickland rector of services for children with special health care needs, u.s. department of health care services. mr. william ditto director of the new jersey tbi division, new jersey health.

dr. flaura woodson with children's hospital in philadelphia and dr. mark ashley president of center for narrow skills. your written testimony will be made part of the record and we assets you summarize your opening statements in five minutes and dr. strickland you are recognized at this time for five minutes to summarize your opening statement. >> chairman pitts, ranking member pallone and members of the subcommittee thank you or the opportunity to testify today on the department of health and human services traumatic brain injury program. and dr. bonnie strickland rector of the division of services for children with health care needs and maternal and child health bureau and resources and services administration department of health and human services. are hhs colleagues at appreciate your interest in our work and we welcome the opportunity to discuss her tbi program with you and provide highlights of others activities. congress has charged her so with implementing the grant program

to improve access to rehabilitation service. the nhs to the responsibility in areas of research in the cdc has the responsibility for prevention and surveillance. we also conduct activities for the authority provided in the public health service act. hrsa's program consists of two distinct -- distinct gap programs and protection and advocacy grants. state partnership grants he'd are required to have our develops a wide needs and resources assessment and a comprehensive statewide action plan. with these tools states have made remarkable progress in increasing access to tbi services and support through tbi screening programs, training health professors and service coordination. hrsa's at busy programs provide specialized legally based services to help recipients understand laws to facilitate training and self advocacy and ensures individual tbi and their families can pursue needed fat

services even if outside representation is unavailable. and age's primary responsibility for tbi research with the rest of the research conflict in the complexity of problems tbi present both immediately and in the aftermath of the injury. for example nih supports studies of the mechanisms of damage, development it up diagnostics and therapy clinical trials and research on brain toxicity and recovery. nih also leads a broad range of research related tbi rehabilitation, appalled by the elderly and disorders that caught her with tbi such as post-traumatic stress disorder. the cdc is responsible for tbi prevention and surveillance. the agency disseminate to implement evidence-based tbi educational materials and clinical guidelines inform seven policies to activities such as the heads-up initiative and educates health departments and community-based organizations on shaken baby syndrome. cdc also works with national experts to produce the triage

guidelines for institution which provides uniform standards for emergency medical service providers and first responders to ensure that patients with tbi are taken to hospitals best suited to address their particular injury. since it the it focuses primarily on behavioral health aspects of tbi sampson maintained strong partnerships with the dav and deity to prepare but health care systems to provide services that reflect an understanding of military culture, service members experiences in the range of potential posttrauma effects. this is primarily accomplished through the servicemembers, veterans and families policy academy. additionally sampson has developed training materials for behavioral health providers who encounter veterans are servicemembers with tbi. in 2011 hrsa convened the first meeting of federal inter-agency committee on triadic brain injury in order to share information, phyllis eight -- facilitate collaboration. to facilitate this purpose the

committee plans to gratis centralized on line clearinghouse of federal resources. the current representatives on the committee of the department of defense education and veterans affairs, the social security administration and within hh is the agency for quality, indian health service, cdc, nih samhsa and hrsa. agencies complement each other. for example cdc surveillance they identify an abnormally high incidence of tbi in child athletes and their particular state and may develop educational material to address the issue. hrsa's state grantee might use the material to conduct a statewide education campaign for students, parents and schools without the risk and consequences of tbi. likewise her so's grantee might utilize the screening protocol in order to implement a student athlete tbi screening program. in addition to education and screening, hrsa which connects students and families with

needed resources, strategies like these allow hrsa grantees to leverage resources of other agencies to identify and serve children who sustain a tbi. opportunities for such collaboration is a the key focus of the nra to committee. we are committed to ensuring individuals with tbi and their families have accessible and appropriate services and support nih, cdc and stamps are making strides in their respective areas of research, prevention and surveillance in behavior health. we are working to ensure that efforts are our efforts are complementary and to achieve collaboration and strategic leveraging of resources to address the full spectrum of needs of individuals and families impacted by tbi. mr. chairman this completes my prepared remarks and was again thank you for the opportunity to testify today and provide an overview of our tbi program. >> the chair thanks gentlelady and recognizes mr. ditto for five minutes for your opening statements.

>> thank you very much chairman pitts and ranking member pallone from new jersey. to clear things up i'm the retired director of the division of disability services in the new jersey department of human services. since i've been given a variety of interesting previous titles what i was introduced. i'm really here today not so much in that role but more in my role as chair of the public policy committee for the national association of states head injury administrators, better known as snapshot. we are the only nonprofit organizations that represent state government agencies and services you'll are involved in the provision of short and long-term rehabilitation and community services for individuals with tbi and their families. i am pleased to give you an opportunity to understand where state government stance with regard to serving individuals. the big item here that i want to

emphasize is that no two individuals with tbi are the same and neither are any two states the same with regard to the extent that they are able to address these needs. the common thread throughout this country is that brain injury is in fact the leading cause of disability. only in the state of new jersey but all across the country. and i think this has not been recognized and not been recognized well. if you go out on the street and ask folks, we have mental retardation, cerebral palsy and autism and all sorts of different things but in impacted his head injury and head injuries such a disability because it is cradle to grave. it affects people in all age categories. as a result individuals with this type of disability have to interface with a lot of different governmental programs over their time as a survivor of

brain injury and is someone on the panel, on the committee, has already mentioned individuals with rain injuries are in fact surviving and they are thriving to the extent that they can get services that they need. in the early 80s, families began advocating for states to provide rehabilitation and other services and there are so many different needs for people with brain injuries. there really are no two individuals with brain injuries who are just the same. we also have the mild, moderate and severe classification of brain injury which makes it in my experience a little less clear-cut. in many forms of disability we can quite clearly states what the extent of the disability is through clinical observation and mental evaluation. this is not true with brain injury. not only that but there was for a long time the feeling that people with brain injury could

only achieve a certain plateau, a certain level and nothing would happen after that. research has proven individuals even 10 years post-brain injury could make significant improvements when given the right services. about 20 states administer medicaid community-based services programs for individuals with disabilities that are intended to provide for service in lieu of more expensive institutional or long-term care. are a big concern at this point is that the systems need to be courted and they need to be available to people of all ages. we have found from the cdc who has moved brain injury up to the top of his list of concerns, when it was not always at the top of the list, we have found the leading cause right now is false. falls in individuals over the age of 75 and i think we are all

familiar with the baby boomers and where we are headed with that. i myself would one of them and in addition to that children under four. look at the age spectrum we have with people suffering from brain injuries throughout the progression of life. it's not just the typical younger adult male crash victim or the returning servicemember. it's really a large number of people. and people, individuals with brain injuries and their families are specifically looking to states for help and support. we would propose in terms of the federal hrsa tbi grant program that the grants be shifted away from short-term projects to allow to maintain and expand initiatives. we would ask states are given additional flexibility to give funds for state services, that states can target their rent request some populations which they identify as underserved and the program loop